There is little or no reliable scientific evidence to support the effectiveness of long-term opioid use to treat chronic pain. In fact such use raises the risk of dependence, addiction and overdose, and new alternative treatments are needed, says a landmark study of prescribing habits and results on patients across the country. The study cuts through the many years of false and misleading information propagated by the pharmaceutical painkiller industry - information that caused years of confusion among medical professionals about long-term use of opioid painkillers, particularly for chronic pain. The situation has been tough for most doctors, who have never been certain that they're providing the best standard of care. The lack of trustworthy, science-based opioid treatment standards has meant chronic pain patients are often overtreated or undertreated - both losing propositions for everyone involved. In addition to the confusion surrounding the use of opioids, chronic pain itself is confusing. Depending on what med school you went to or expert you follow, chronic pain can mean any pain that lasts longer than 3 months, or 6 months, or a year, or several combinations of those. It can even mean a no-time-limit definition that says 'chronic pain is any pain that lasts longer than the expected period of healing.' Hopefully, most of the reasons for the dilemma may soon be resolved. A nationwide, large-scale evidence review of prescription opioid history and use was presented at a National Institutes of Health (NIH) "Pathways To Prevention" workshop last September. The reports from that conference have just been published in the Annals of Internal Medicine, setting the stage for a new era in long-term opioid prescribing.

According to the evidence, the findings are clear

The evidence review spells out the real situation with opioids and chronic pain. And it isn't a pretty picture:

No reliable scientific evidence exists to support the safety and effectiveness of opioids for long-term treatment in chronic pain.

In fact, most randomized, controlled trials of opioids for chronic pain were shorter than 6 weeks, and almost none exceeded 16 weeks - less than adequate for most chronic pain.

There is ample evidence of harm including increased risks of overdose and abuse. Opioid therapy for chronic pain is associated with the following (in addition to the many known side effects of opioids for even short treatment periods):

increased risk for overdose

opioid abuse

fractures

sexual dysfunction

myocardial infarction

Higher doses, as opposed to longer term treatment, are also associated with increased risks of some harms.

Evidence for the effectiveness and harms of different opioid dosing and risk mitigation strategies is also limited.

The workshop was co-sponsored by the NIH Office of Disease Prevention, the National Institute of Neurological Disorders and Stroke, the National Institute on Drug Abuse and the NIH Pain Consortium. Most of these agencies are now involved in drafting a new National Pain Strategy - a science-based strategy that hopes to create standards for the use of opioids in chronic pain management as well as finding alternative solutions for chronic pain.

Misleading information was based on paid-for false claims

To get an historical perspective on how and why the medical profession has been so far off base with opioids, you have to learn a little bit about a dark period in our medical past. Here we are in 2015, and many doctors are still overprescribing opioids. But the truth of the matter is that their decisions stem from false assurances from the painkiller industry and dozens of highly-paid "medical experts" on Big Pharma's payroll. This marketing strategy convinced most of the medical profession, both here and abroad, to go ahead and write lots and lots of opioid prescriptions and everything will be okay. As reported in a series of investigative reports by MedPage Today in partnership with the Milwaukee Journal, the narcotic painkiller industry's medical shills not only promoted the safety and effectiveness of opioids, they also advocated for fewer regulations to counter the claims of a vocal minority of responsible doctors who have been calling for tighter regulations for years. A number of well-known medical experts, especially at the University of Wisconsin's "UW Pain Group," were paid millions of dollars. For example, two UW Pain Group physicians received over $2.5 million, a MedPage Today/Journal Sentinel article said, most of it paid before they ever wrote their articles and speeches. The MedPage Today/Journal Sentinel investigative report carefully documented how dozens of UW doctors "hired themselves out as promotional speakers for drug companies or were enriched by lucrative royalty and consulting deals with medical device makers. At the same time, the medical school itself has pulled in millions of dollars in pharmaceutical industry money to sponsor courses for doctors that critics say have questionable educational value." One of the major offenders of these questionable tactics, said the reports, was Purdue Pharma, maker of OxyContin. Purdue was subsequently charged and found guilty by the federal government of fraudulent claims and illegal marketing, and was fined $615 million. Other lawsuits against other narcotic industry players have resulted in even higher fines, and even larger suits are still pending in California, Illinois and Tennessee.

Opioids are ok for some, but more effective approaches are needed

With that background understanding, you can see that to get at the underlying truth in general practice today, real, unbiased evidence-based research was needed. The NIH named the Agency for Healthcare Research and Quality to manage a study, and in turn, it contracted the Pacific Northwest Evidence-based Practice Center to perform it. To undercut the years of false information, the report addressed these questions:

What is the long-term effectiveness of opioids for treatment for chronic pain?

What are the safety and harms of opioids in patients with chronic pain?

What are the effects of different opioid management strategies?

What is the effectiveness of risk mitigation strategies for opioid treatment?

These questions and more are being answered, and most of the workshop panel, a Who's Who of leading medical clinicians and educators from all across the country, are now involved in coming up with the new strategy for opioid use, chronic pain management and alternative therapies. "The lack of scientific evidence on effectiveness and harms of long-term opioid therapy for chronic pain is clear and is in striking contrast to its widespread use for this condition and the large increase in prescription opioid-related overdoses," said Dr. Roger Chou of Oregon Health and Science University and colleagues, who conducted the actual research. Drawing heavily from the Chou report, the panelists put together a concluding paper that says that opioids may work for some patients, "but there are probably more effective approaches for many others." The NIH says the report is intended to "help health care decision-makers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services." Hopefully, these findings will result in useful new standards from which clinicians and patients both will benefit - not just guidelines for long-term opioid use, but effective alternative pain relief strategies outside of opioids that clinicians=20 will adopt into their practices - something that has not existed before. Such an outcome can only be positive for doctors and especially for their patients. Meanwhile, here at Novus, we continue to help patients almost every day who have fallen prey to prescription opioids, originally prescribed by their physicians, that got out of hand and led to dependence and addiction. If you or someone you care for has any kind of problems with or questions about prescription opioids, don't hesitate to give us a call. We specialize in helping people get their lives back.

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